| NPI | 1770787087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA DITTHARDT Office Manager 954-964-4113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME62894) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME64761) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-08-22 |